Credentialing Specialist

Job Summary

Managing delegated credentialing activities, the full-time Credentialing Specialist will oversee payer audits, compliance reporting, and provider-data reconciliation while working remotely.

Key responsibilities

• Oversee delegated credentialing activities for assigned payer portfolios, including audits and compliance monitoring
• Prepare and facilitate credentialing audits, developing corrective action plans as necessary
• Lead the credentialing process for Nurse Practitioners and group practices, ensuring accurate documentation and timely submissions

Required qualifications

• 2-5 years of credentialing and enrollment experience, with at least 2 years focused on delegated credentialing
• Certified Provider Credentialing Specialist (CPCS) certification
• Ability to manage multiple payer relationships with minimal oversight
• Experience in high-growth or tech-enabled healthcare settings; behavioral health experience preferred
• Familiarity with credentialing software and payer rostering tools